---
title: 'Senior Appeals & Denials Resolution Manager at Big Health'
canonical: 'https://feeny.ai/job/senior-appeals-denials-resolution-manager-big-health-united-states-7vj9ppk5tzmz'
type: 'job'
last_seen: '2026-11-11'
---

# Senior Appeals & Denials Resolution Manager at Big Health

- **Company:** Big Health
- **Location:** United States
- **Compensation:** $120k–$140k
- **Employment:** full-time
- **Work type:** remote
- **Posted:** 2026-11-10
- **Last confirmed live:** 2026-11-11
- **Apply:** https://jobs.lever.co/bighealth/6404d6a1-7cb4-4f7c-b41a-76e0138c4988

## Job description

## Our Mission

At Big Health, our mission is to help millions back to good mental health by providing fully digital, non-drug options for the most common mental health conditions. Our FDA-cleared digital therapeutics—SleepioRx for insomnia and DaylightRx Treatment for anxiety—guide patients through first-line recommended, evidence-based cognitive and behavioral therapy anytime, anywhere. Our digital program, Spark Direct, helps to reduce the impact of persistent depressive symptoms.

In pursuit of our mission, we’ve pioneered the first at-scale digital therapeutic business model in partnership with some of the most prominent global healthcare organizations, including leading Fortune 500 healthcare companies and Scotland’s NHS. Through product innovation, robust clinical evaluation, and a commitment to equity at scale, we are designing the next generation of medicine and the future of mental health care.

Our Vision Over the next 5-10 years, we believe digital therapeutics will transform the delivery of healthcare worldwide by providing access to safe and effective evidence-based treatments. Big Health is positioned to take the lead in this transformation.

Big Health is a remote-first company, and this role can be based anywhere in the US. Position Summary Big Health is seeking an experienced, results-driven Senior Appeals & Denials Resolution Manager to establish and lead payer appeals and denial resolution operations. This role will independently investigate difficult denials, develop persuasive evidence-based appeals, engage payer reviewers and decision-makers, and own cases through appropriate levels of review. They will also design scalable workflows, documentation standards, reporting, and quality controls, using AI-enabled technology to improve efficiency while maintaining human oversight.

## Key Responsibilities

- Appeals Management & Denial Resolution
- Manage end-to-end appeals operations from denial intake through resolution, including prioritization, workload allocation, quality oversight, and timely execution of initial and second-level appeals, reconsiderations, and external reviews when applicable.
- Personally handle complex medical necessity, investigational/experimental, noncovered service, coding, and reimbursement-related denials.
- Build case-specific appeal strategies supported by clinical records, research, payer policies, coding guidance, and applicable appeal requirements.
- Assess deadlines, documentation needs, appeal merit, escalation options, and case closure decisions; ensure timely and accurate submissions.
- Payer Investigation & Escalation
- Communicate directly with payer claims, provider relations, medical policy, utilization management, and clinical review teams as appropriate.
- Ask probing questions to identify the actual basis for denials or upheld decisions and determine what evidence, review, or corrective action could change the outcome.
- Distinguish benefit exclusions and coverage-policy restrictions from administrative errors, coding problems, documentation gaps, and pricing disputes.
- Document payer contacts, reference numbers, policy citations, findings, commitments, and follow-up actions; escalate systemic policy issues to Market Access leadership.
- Operations & Process Development
- Build standardized operating procedures for intake, triage, appeal drafting, submission, follow-up, escalation, quality review, and closure.
- Maintain complete case records covering denial rationale, appeal history, evidence, correspondence, deadlines, and final disposition.
- Manage operational capacity, workload prioritization, productivity expectations, provider communication standards, and quality controls to ensure timely resolution and prevent missed appeal deadlines.
- Coordinate with providers and cross-functional partners to obtain complete supporting documentation and resolve exceptions.
- AI-Enabled Appeals Operations
- Serve as operational owner for AI-supported appeals workflows, including draft generation, document review, tracking, and routine payer follow-up.
- Independently review AI-produced outputs for factual accuracy, evidence quality, completeness, and payer-specific requirements.
- Retain human responsibility for appeal submission, complex payer engagement, judgment-intensive exceptions, and quality assurance.
- Identify workflow improvements while adhering to privacy, security, and compliance requirements.
- Performance, Reporting & Leadership
- Track appeal overturn rates by payer, denial reason, and level; case aging; cycle times; reimbursement recovered; workload; and recurring root causes.
- Translate payer findings into recommendations that improve operational performance and inform the broader access and reimbursement strategy.
- Provide regular reporting to Market Access leadership and work closely with Clinical, Legal, Finance, and provider-facing teams.
- Serve as the operational leader and primary subject-matter expert for appeals and denial resolution, accountable for team readiness, performance standards, training, and oversight of additional resources as the function scales.
- Own operational performance against defined KPIs, identify resource and staffing needs, and recommend improvements to support scalability and business objectives.

Required Skills and Experience

- Required
- Bachelor’s degree in healthcare administration, business, health sciences, or related discipline, or equivalent professional experience
- 7+ years of progressive experience in healthcare reimbursement, revenue cycle, denial management, or payer appeals, including 3+ years of complex-appeal ownership and 0-2 years of management experience, with demonstrated experience leading operational workflows, managing performance, or overseeing appeals resources
- Demonstrated record of successfully overturning challenging commercial payer denials, with ability to explain investigative methods and results
- Working knowledge of commercial payer and Medicare appeal processes, medical policies, CPT/HCPCS coding, remittance advice, denial codes, and reimbursement methodologies
- Excellent appeal-writing skills, payer communication and escalation judgment, detailed case documentation, and analytical problem-solving
- Experience designing operational workflows, managing substantial case volumes, and meeting payer-specific timelines with limited supervision
- Strong analytical skills, including data analysis and resource management
- Preferred Qualifications
- Experience in behavioral health, digital health, medical devices, specialty healthcare, or emerging technologies
- Familiarity with appeals involving newer HCPCS codes, FDA-cleared therapies, investigational policies, and independent external review
- Experience transitioning outsourced appeals in-house or implementing AI-supported revenue cycle software
- Relevant credentials such as CPC, CPMA, or CRCR; experience mentoring or supervising appeals staff

We at Big Health are on a mission to bring millions back to good mental health, in order to do so, we need to reflect the diversity of those we intend to serve. We’re an equal opportunity employer dedicated to building a culturally and experientially diverse team that leads with empathy and respect. Additionally, we will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the San Francisco Fair Chance Ordinance.

Big Health participates in E-Verify for all new hires in the United States.

## About Big Health

## Company Overview
- **One-liner**: Big Health provides clinically validated, fully digital mental health treatments for insomnia, anxiety, and adolescent depression, delivered through app-based programs to employers, health plans, and health systems.
- **Entity Type**: Private (Series C, Venture Round)
- **Headquarters**: San Francisco, California, United States
- **Founded**: 2010
- **Founders**: Peter Hames, Dr. Colin Espie

## Core Business
- **Primary industry**: Digital Therapeutics / Mental Health Care
- **Target customers**: B2B – employers, health plans, health systems & providers; B2C indirectly through benefits
- **Mission**: To help millions back to good mental health by combining clinical expertise with design and technology

## Products & Services
- **[Sleepio Rx](https://www.bighealth.com/)**: FDA-cleared digital therapeutic for insomnia disorder, based on cognitive behavioral therapy (CBT-I). Delivered as a prescription treatment for clinical care.
- **[Daylight Rx](https://www.bighealth.com/)**: FDA-cleared digital therapeutic for generalized anxiety disorder (GAD), using CBT techniques.
- **[Spark Direct](https://www.bighealth.com/)**: Digital program for adolescent depression (acquired via Limbix in 2023).
- **Workplace mental health solutions**: Custom engagement strategies for employers, including access to Sleepio, Daylight, and Spark Direct as employee benefits.

## Market Standing
- **Valuation**: Not publicly disclosed
- **Key Metric**: Annual revenue of $12.5 M (2025 estimate) – [linkedin.com/company/big-health](https://linkedin.com/company/big-health)
- **Total Funding**: Over $100 M (Series C $75 M led by SoftBank Vision Fund in 2022; Venture Round $23.7 M in 2026 led by .406 Ventures and AlleyCorp; earlier Series A $3.3 M led by Index Ventures) – [linkedin.com/company/big-health](https://linkedin.com/company/big-health)
- **Notable Investors/Partners**: SoftBank Vision Fund, Index Ventures, .406 Ventures, AlleyCorp
- **Growth Signals**: 
  - 500K+ patients treated; 9.8/10 satisfaction score – [bighealth.com](https://www.bighealth.com/)
  - FDA 510(k) clearance for SleepioRx (August 2024) – [linkedin.com/company/big-health](https://linkedin.com/company/big-health)
  - Acquired Limbix in 2023 to expand into adolescent mental health – [linkedin.com/company/big-health](https://linkedin.com/company/big-health)
  - 100+ peer-reviewed publications and randomized controlled trials – [bighealth.com](https://www.bighealth.com/)
  - Employee headcount grew 4.7% YoY to 59 people – [linkedin.com/company/big-health](https://linkedin.com/company/big-health)

## Competitive Advantages
- **Clinical validation**: More than 100 peer-reviewed publications and multiple RCTs backing their digital treatments.
- **FDA clearance**: SleepioRx and DaylightRx are FDA-cleared as prescription digital therapeutics, giving them credibility with health systems and insurers.
- **Proven scalability**: Digital-only delivery eliminates waitlists and geographical barriers, enabling rapid deployment to large employers and health plans.
- **First-line treatment focus**: CBT‑I and CBT are recommended as first-line therapies for insomnia and anxiety, aligning with clinical guidelines.

## Strategic Focus
- **Expanding into adolescent mental health** through the Limbix acquisition and Spark Direct program.
- **Growing health plan and health system partnerships** by leveraging FDA‑cleared, reimbursable digital therapeutics.
- **Continued investment in clinical research** to expand the evidence base and secure additional regulatory clearances.
- **Scaling the employer channel** with custom engagement strategies for large organizations (e.g., nurses, truck drivers, remote workers).

## Why Work Here
- **Remote‑friendly since 2010**: Over 70% of employees are remote, with a distributed team across the US, UK, and Colombia. The company has a decade of experience supporting distributed teams – [bighealth.com/careers](https://www.bighealth.com/careers)
- **Mission‑driven culture**: United by the goal of making evidence‑based mental health care accessible to all, including underserved communities.
- **Comprehensive benefits**:
  - 100% employee coverage for medical, vision, and dental – [bighealth.com/careers](https://www.bighealth.com/careers)
  - Free access to Sleepio, Daylight, and Spark Direct for employees and dependents
  - 20 vacation days + 9 federal holidays + end‑of‑year closure
  - $1,000 USD / £800 stipend for professional development
  - 401(k) with company match (US) / NEST pension (UK)
  - Parental leave from day one; dependents get 50% coverage on medical plans
- **Annual in‑person Summit** at San Francisco HQ (virtual when needed) and regular social events – [bighealth.com/careers](https://www.bighealth.com/careers)
- **Diversity, equity, and inclusion**: Explicit commitment to DEI; hiring process may use AI tools but final decisions are made by humans – [jobs.lever.co/bighealth](https://jobs.lever.co/bighealth)

## Sources
1. [bighealth.com/careers](https://www.bighealth.com/careers)
2. [bighealth.com/about-us](https://www.bighealth.com/about-us)
3. [bighealth.com](https://www.bighealth.com/)
4. [linkedin.com/company/big-health](https://linkedin.com/company/big-health)
5. [jobs.lever.co/bighealth](https://jobs.lever.co/bighealth)

## Other roles at Big Health

- [Provider Growth Manager](https://feeny.ai/job/provider-growth-manager-big-health-united-states-y0yxgkjteery) — United States
- [Senior Manager, Key Accounts](https://feeny.ai/job/senior-manager-key-accounts-big-health-united-states-hxq8crp3pwja) — United States